Provider Demographics
NPI:1083917686
Name:ROHDE, CARLYANNE PHIPPS (PSYD)
Entity type:Individual
Prefix:MS
First Name:CARLYANNE
Middle Name:PHIPPS
Last Name:ROHDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MARKET ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6548
Mailing Address - Country:US
Mailing Address - Phone:410-430-1389
Mailing Address - Fax:240-702-0262
Practice Address - Street 1:60 MARKET ST
Practice Address - Street 2:SUITE 213
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6548
Practice Address - Country:US
Practice Address - Phone:410-430-1389
Practice Address - Fax:240-702-0262
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04948103TC0700X
DCPSY1000657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
669LMedicare UPIN